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Introduction: Most providers have routinely performed universal lumbar puncture (LP) on well-appearing, febrile infants 22 to 28 days old. In 2021, the American Academy of Pediatrics recommended clinicians should perform an LP in this age group if inflammatory markers are abnormal. This quality improvement project aimed to decrease LP rates in febrile infants 22 to 28 days old in the emergency department (ED) within 1 year, regardless of race/ethnicity, from a baseline of 87%. Methods: We used our institution's quality improvement framework to perform multiple Plan-Do-Study-Act cycles. A multidisciplinary team reviewed the febrile infant literature, local epidemiology, and identified key drivers. We provided departmental education, updated our clinical pathway, and used clinical decision support. We analyzed baseline (January 2017-March 2022) and intervention data (April 2022-March 2024) and tracked data using statistical process control charts. Our primary outcome measure was rates of LP in the ED for this cohort. Process measures included rates of infants with procalcitonin results. ED length of stay, rates of first LP attempt after hospitalization, and missed bacterial meningitis were balancing measures. Results: The baseline LP rate of 87% decreased to 44% during the intervention period, resulting in a downward centerline shift. There were no significant differences when LP rates were analyzed by race/ethnicity. There was an upward centerline shift in the process measure of infants with procalcitonin results. There was no observed special cause variation in our balancing measures. Conclusion: Quality improvement efforts, including education, clinical pathway updates, and clinical decision support, safely reduced rates of LPs in febrile infants 22 to 28 days old.

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Our goal was to identify predictors of invasive bacterial infection (ie, bacteremia and bacterial meningitis) in febrile infants aged 2-6 months. In our multicenter retrospective cohort, older age and lower temperature identified infants at low risk for invasive bacterial infection who could safely avoid routine testing.

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In this multicenter, cross-sectional, secondary analysis of 4042 low-risk febrile infants, nearly 10% had a contaminated culture obtained during their evaluation (4.9% of blood cultures, 5.0% of urine cultures, and 1.8% of cerebrospinal fluid cultures). Our findings have important implications for improving sterile technique and reducing unnecessary cultures.

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ABSTRACT: Multisystem inflammatory syndrome in children (MIS-C) is a syndrome of abnormal immune response after severe acute respiratory syndrome coronavirus 2 infection that can result in organ dysfunction including severe cardiovascular compromise in children. Increased evidence supports a clinical and laboratory profile in MIS-C distinct from Kawasaki disease, with MIS-C typically occurring in older children and with more prominent gastrointestinal and neurologic symptoms, as well as increased inflammation, lymphopenia, and cardiac injury on laboratory testing. However, high-level evidence regarding best practices for treatment and long-term outcomes in MIS-C is limited.

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O estudo de desarranjos do neurodesenvolvimento, sejam estes herdados ou adquiridos, necessita da integração cada vez mais aprofundada entre pesquisa básica e abordagem clínica. Apesar da análise do comportamental humano ser essencial para caracterizar e motivar a inovação científica nas várias condições clínicas e/ ou de disfunção social, os estudos comportamentais bem controlados utilizando modelos animais favorecem a ponte do conhecimento entre o laboratório e o clínico populacional. No comportamento social fino e adaptado às espécies animais de experimentação científica, estudos de comunicação ultrassônica em camundongos vem sendo de extrema importância para esclarecimento de achados comportamentais de linguagem em correspondentes em condições humanas. O presente estudo busca consolidar um paradigma de investigação comportamental em linguagem utilizando um modelo murino de linhagem selvagem C57/BL6 no contexto de vocalização ultrassônica na separação materna estabelecida em filhotes pré-adolescentes. Além da determinação e aplicação do protocolo experimental aqui relatado, os resultados demonstraram que não houve diferenças nas idades analisadas e corroboram com os dados descritos em literatura uma vez que ocorreu uma inclinação para comunicação de baixa complexidade.(AU)

Neurodevelopmental disorders can be inherited or acquired and requires deeper integration between basic and clinical research. The access and analysis of human behavior patterns are essential to push for scientific innovation in various clinical conditions and/or social dysfunction, but clinical and psychological approach can be challenging to achieve in these conditions. Thus, behavioral studies using animal models in experimental settings favor and advance the understanding of neurodevelopmental disarrangements in human population. In this regard, social behavior testing in fine and elaborate cognitive skills such as ultrasonic vocalization in mice have been extremely important to study behavioral findings of language dysfunction in human condition. Therefore, the present study seeks to consolidate a behavioral investigation paradigm in language using a murine model of wild line C57/BL6 in the context of ultrasonic vocalization in the maternal separation established in pre-adolescent subjects. Besides the establishment and application of the experimental design reported here, the results showed a trend for low complexity communication manifested by the pre-adolescent offspring with no differences regarding age or sex in tested animals.(AU)

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O estudo de desarranjos do neurodesenvolvimento, sejam estes herdados ou adquiridos, necessita da integração cada vez mais aprofundada entre pesquisa básica e abordagem clínica. Apesar da análise do comportamental humano ser essencial para caracterizar e motivar a inovação científica nas várias condições clínicas e/ ou de disfunção social, os estudos comportamentais bem controlados utilizando modelos animais favorecem a ponte do conhecimento entre o laboratório e o clínico populacional. No comportamento social fino e adaptado às espécies animais de experimentação científica, estudos de comunicação ultrassônica em camundongos vem sendo de extrema importância para esclarecimento de achados comportamentais de linguagem em correspondentes em condições humanas. O presente estudo busca consolidar um paradigma de investigação comportamental em linguagem utilizando um modelo murino de linhagem selvagem C57/BL6 no contexto de vocalização ultrassônica na separação materna estabelecida em filhotes pré-adolescentes. Além da determinação e aplicação do protocolo experimental aqui relatado, os resultados demonstraram que não houve diferenças nas idades analisadas e corroboram com os dados descritos em literatura uma vez que ocorreu uma inclinação para comunicação de baixa complexidade.

Neurodevelopmental disorders can be inherited or acquired and requires deeper integration between basic and clinical research. The access and analysis of human behavior patterns are essential to push for scientific innovation in various clinical conditions and/or social dysfunction, but clinical and psychological approach can be challenging to achieve in these conditions. Thus, behavioral studies using animal models in experimental settings favor and advance the understanding of neurodevelopmental disarrangements in human population. In this regard, social behavior testing in fine and elaborate cognitive skills such as ultrasonic vocalization in mice have been extremely important to study behavioral findings of language dysfunction in human condition. Therefore, the present study seeks to consolidate a behavioral investigation paradigm in language using a murine model of wild line C57/BL6 in the context of ultrasonic vocalization in the maternal separation established in pre-adolescent subjects. Besides the establishment and application of the experimental design reported here, the results showed a trend for low complexity communication manifested by the pre-adolescent offspring with no differences regarding age or sex in tested animals.

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OBJECTIVE: To determine factors associated with adverse outcomes among febrile young infants with invasive bacterial infections (IBIs) (ie, bacteremia and/or bacterial meningitis). STUDY DESIGN: Multicenter, retrospective cohort study (July 2011-June 2016) of febrile infants ≤60 days of age with pathogenic bacterial growth in blood and/or cerebrospinal fluid. Subjects were identified by query of local microbiology laboratory and/or electronic medical record systems, and clinical data were extracted by medical record review. Mixed-effect logistic regression was employed to determine clinical factors associated with 30-day adverse outcomes, which were defined as death, neurologic sequelae, mechanical ventilation, or vasoactive medication receipt. RESULTS: Three hundred fifty infants met inclusion criteria; 279 (79.7%) with bacteremia without meningitis and 71 (20.3%) with bacterial meningitis. Forty-two (12.0%) infants had a 30-day adverse outcome: 29 of 71 (40.8%) with bacterial meningitis vs 13 of 279 (4.7%) with bacteremia without meningitis (36.2% difference, 95% CI 25.1%-48.0%; P < .001). On adjusted analysis, bacterial meningitis (aOR 16.3, 95% CI 6.5-41.0; P < .001), prematurity (aOR 7.1, 95% CI 2.6-19.7; P < .001), and ill appearance (aOR 3.8, 95% CI 1.6-9.1; P = .002) were associated with adverse outcomes. Among infants who were born at term, not ill appearing, and had bacteremia without meningitis, only 2 of 184 (1.1%) had adverse outcomes, and there were no deaths. CONCLUSIONS: Among febrile infants ≤60 days old with IBI, prematurity, ill appearance, and bacterial meningitis (vs bacteremia without meningitis) were associated with adverse outcomes. These factors can inform clinical decision-making for febrile young infants with IBI.

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OBJECTIVES: To help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities. STUDY DESIGN: Cross-sectional study of infants ≤60 days old with invasive bacterial infection (bacteremia and/or bacterial meningitis) evaluated in the emergency departments of 11 children's hospitals between July 1, 2011 and June 30, 2016. Each site's microbiology laboratory database or electronic medical record system was queried to identify infants from whom a bacterial pathogen was isolated from either blood or cerebrospinal fluid. Medical records of these infants were reviewed to confirm the presence of a pathogen and to obtain demographic, clinical, and laboratory data. RESULTS: Of the 442 infants with invasive bacterial infection, 353 (79.9%) had bacteremia without meningitis, 64 (14.5%) had bacterial meningitis with bacteremia, and 25 (5.7%) had bacterial meningitis without bacteremia. The peak number of cases of invasive bacterial infection occurred in the second week of life; 364 (82.4%) infants were febrile. Group B streptococcus was the most common pathogen identified (36.7%), followed by Escherichia coli (30.8%), Staphylococcus aureus (9.7%), and Enterococcus spp (6.6%). Overall, 96.8% of pathogens were susceptible to ampicillin plus a third-generation cephalosporin, 96.0% to ampicillin plus gentamicin, and 89.2% to third-generation cephalosporins alone. CONCLUSIONS: For most infants ≤60 days old evaluated in a pediatric emergency department for suspected invasive bacterial infection, the combination of ampicillin plus either gentamicin or a third-generation cephalosporin is an appropriate empiric antimicrobial treatment regimen. Of the pathogens isolated from infants with invasive bacterial infection, 11% were resistant to third-generation cephalosporins alone.

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